CHICAGO -- Most men with stage I seminoma can safely enter surveillance and avoid unnecessary therapy without jeopardizing survival, according to data from a large registry.

Records from more than 1,800 men showed a recurrence rate of 20% and a disease-specific survival of more than 99% after a median follow-up of 15 years. Most relapses occurred within the first 2 years after surgical removal of the involved testicle.

"Surveillance is a safe strategy for stage I seminoma patients," Mette S. Mortensen, MD, of Rigshopitalet and Copenhagen University Hospital in Denmark, said during a press briefing prior to the American Society of Clinical Oncology meeting.

"Patients with stage I seminoma have an excellent disease-specific survival, and 80% of the patients avoid unnecessary treatment after orchiectomy."

Since 1984, orchiectomy followed by surveillance has been the standard approach to treating stage I seminoma. The 5-year follow-up regimen consists of periodic clinical visits, CT scans or x-rays, and measurement of tumor markers.

In the U.S., the National Comprehensive Cancer Network clinical guideline for testicular cancer specifies surveillance as the preferred option for patients with stage IA or IB seminoma. Adjuvant therapy with single-agent carboplatin or radiation therapy are acceptable alternatives.

Though standard practice in much of the world, long-term outcomes of surveillance for stage I seminoma had not been assessed in a large cohort. To address that issue, Mortensen and colleagues searched medical records and linked them to cancer registries to identify men who had newly diagnosed stage I seminoma from 1984 through 2007. Limiting the search to men who entered surveillance after removal of the affected testicle, investigators identified 1,822 men for the analysis.

Follow-up continued through December 2012, resulting in a median follow-up of 15.4 years and a range of 0 to 28 years. Mortensen reported that 355 relapses were documented (19.5%). The median time to relapse was 13.7 months and ranged from 1.2 to 173.7 months.

The vast majority of relapses (73%) occurred within the first 2 years after primary treatment. Mortensen reported that 72 relapses (20.3%, or 4.0% of all patients) occurred during years 2 to 5, and 26 patients (7.3%, 1.4%) relapsed more than 5 years after treatment. Multivariate analysis identified three predictors of relapse: tumor size greater than 4 cm, disease spread to blood or lymphatic vessels, and pretreatment serum human chorionic gonadotropin levels exceeding 200 IU/L (P<0.01).

The records showed that 10 patients died of testicular cancer or treatment-related causes, resulting in a disease-specific survival of 99.45%. The cohort had 15-year overall survival 92.1%.

Despite excellent long-term survival in patients with stage I seminoma, no accepted standard of postoperative follow-up exists, ASCO president-elect Clifford Hudis, MD, of Memorial Sloan-Kettering Cancer Center in New York City, said during a brief discussion of the findings. Patients have received adjuvant chemotherapy and radiation therapy, whereas others have entered surveillance.

Noting that the study showed a 99.6% 10-year disease-specific survival, Hudis said, "To put that into plain numbers, that means that only four out of every 1,000 patients will die from this cancer over a decade of follow-up. As highlighted by this study, broad treatment is probably not necessary.

"These results will encourage doctors and patients to opt for surveillance instead of treatment and spare patients from additional therapy and related complications, which are well known in the medical community."

The study was supported by the Danish Cancer Society, the Danish Cancer Research Foundation, and the Preben and Anna Simonsen Foundation.

Mortensen and co-investigators reported no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco

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